Important

Your login session will expire in seconds

Would you like to extend your session?

Forms

Please reference the contract number on each page of all forms and any accompanying correspondence. A newly completed form is required for all requests. Forms that have been reused will not be honored.

Jackson recognizes that information security is critical to maintaining the trust of our customers and advisors. To protect customer data, some forms may be accessed only after logging into our website. Click the "Sign In" button at the top right of this page to get started.

  • Filter By:
    • All
    • Fixed Annuity
    • Indexed Annuity
    • Life
    • Variable Annuity
    • All
    • Action
    • Action (NY)
    • Action 2
    • Action 200 (NY only)
    • Action 7 (NY only)
    • Action One
    • Advisor VUL
    • Annuitized Fixed Annuity
    • Bonus Max
    • Bonus Max One
    • Bonus Max Two
    • Brooke Life Annuities
    • Brooke Life Ins Co - Partner 5
    • Brooke Life Ins Co-Credit Union ONE only
    • Brooke Life Ins Co-DFCU Unity Plus only
    • Brooke Life Ins.Co-Citizens Bank Only
    • Curiangard Simplified Retirement Annuity
    • Decreasing Term
    • Defined Strategies
    • ELI 500/ELI Multi Index Deferred Annuity
    • ELITE 500 Equity Indexed Annuity
    • ELITE 90
    • ELITE 90 MCI
    • ELITE Choice
    • ELITE Choice Rewards
    • Elite Access
    • Elite Access Advisory
    • Elite Access Advisory II
    • Elite Access Brokerage Edition
    • Elite Access II
    • Elite Annual Reset Annuity
    • Fifth Third Perspective (5/3 Bank Only)
    • Fixed Annuity
    • Generations UL
    • Generations ULC
    • Immediate Annuity
    • Jackson Accumulator UL
    • Jackson Advantage
    • Jackson AscenderPlus
    • Jackson AscenderPlus Select
    • Jackson Assure WL (conversion only)
    • Jackson Assure Whole Life
    • Jackson Level Premium Whole Life
    • Jackson Private Wealth
    • Jackson RateProtector
    • LOG Annuity Products
    • LOG Life Products
    • Lifeline Term
    • MarketProtector
    • MarketProtector Advisory
    • MarketProtector Advisory III
    • MarketProtector III
    • Max
    • Max One
    • Max One XL
    • Max Tax Saver
    • Max XL
    • OptiMAX NY (NY only)
    • Optimax
    • Optimax 100
    • Optimax 125
    • Optimax 2
    • Optimax 200
    • Optimax 3
    • Optimax 4
    • Optimax 5
    • Optimax 53 (5/3 Bank Only)
    • Optimax 6
    • Optimax Level Rate One
    • Optimax Level Rate Two
    • Optimax NY Level Rate (NY only)
    • Optimax One
    • Pathfinder
    • Pathfinder (NY only)
    • Perspective
    • Perspective Advantage
    • Perspective Advantage(CT)
    • Perspective Advisors
    • Perspective Advisors II
    • Perspective Advisory
    • Perspective Advisory II
    • Perspective Focus
    • Perspective II
    • Perspective Investor (VUL)
    • Perspective L Series
    • Perspective Rewards
    • Protector 10-Year Term
    • Protector 15-Year Term
    • Protector 20-Year Term
    • Protector 30-Year Term
    • Renewable Term
    • Retirement Latitudes-Raymond James ONLY
    • SLD Life Products
    • Select Annual Reset Annuity
    • SuperMax
    • SuperMax XL
    • Target Select
    • Ultimate Investor VUL
    • Ultimate Plan
    • Universal Life
    • Whole Life
    • Yearly Renewable Term
    • All
    • Account Changes
    • Claims
    • Life Insurance Policy Changes
    • Loans
    • Other Transactions
    • Payments & Deposits
    • Withdrawal
    • All
    • Alabama
    • Alaska
    • Arizona
    • Arkansas
    • California
    • Colorado
    • Connecticut
    • District of Columbia
    • Delaware
    • Florida
    • Georgia
    • Hawaii
    • Idaho
    • Illinois
    • Indiana
    • Iowa
    • Kansas
    • Kentucky
    • Louisiana
    • Maine
    • Maryland
    • Massachusetts
    • Michigan
    • Minnesota
    • Mississippi
    • Missouri
    • Montana
    • Nebraska
    • Nevada
    • New Hampshire
    • New Jersey
    • New Mexico
    • New York
    • North Carolina
    • North Dakota
    • Ohio
    • Oklahoma
    • Oregon
    • Pennsylvania
    • Rhode Island
    • South Carolina
    • South Dakota
    • Tennessee
    • Texas
    • Utah
    • Vermont
    • Virginia
    • Washington
    • West Virginia
    • Wisconsin
    • Wyoming

Form Search Results

Select All
NameDescriptionTransaction TypeForm NumberStates
Accelerated Benefit Claim
Complete to file an accelerated benefit claim. Claims Z1361 04/15 AK, AL, AR, AZ, CA…
AK, AL, AR, AZ, CA, CO, CT, DC, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, VT, WA, WI, WV, WY
Accelerated Benefit Claim
Complete to file an accelerated benefit claim. Claims NZ1361 12/18 NY
Activation of Lifetime Income Benefit Request
Use this form to activate a Lifetime Income Benefit. Other Transactions X4391 06/20 AK, AL, AR, AZ, CA…
AK, AL, AR, AZ, CA, CO, CT, DC, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, VT, WA, WI, WV, WY
Additional Premium for Jackson Advantage
Use this form to apply additional funds using your current allocation or to make allocation changes for this deposit and future deposits, if desired. Payments & Deposits NV6261 04/21 NY
Additional Premium for Perspective, PII, Advisors II, Advisory, Focus, L Series and Rewards
Use this form to apply additional funds using your current allocation or to make allocation changes for this deposit and future deposits, if desired. Payments & Deposits NV6243 04/21 NY
Additional Premium for Perspective Advisory II
Use this form to apply additional funds using your current allocation or to make allocation changes for this deposit and future deposits, if desired. Payments & Deposits NV6260 04/21 NY
Additional Premium for Perspective Advisory II and Jackson Private Wealth
Use this form to apply additional funds using your current allocation or to make allocation changes for this deposit and future deposits, if desired. Payments & Deposits V6260 04/21 AK, AL, AR, AZ, CA…
AK, AL, AR, AZ, CA, CO, CT, DC, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, VT, WA, WI, WV, WY
Add-On Benefit Election/Termination Guaranteed Minimum Withdrawal Benefit
Use this form to add or terminate a GMWB. Other Transactions V4390 04/21 AK, AL, AR, AZ, CA…
AK, AL, AR, AZ, CA, CO, CT, DC, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, VT, WA, WI, WV, WY
Add-On Benefit Election/Termination Lifetime Income Rider/Lifetime Income Benefit
Use this form to add or terminate a Lifetime Income Rider or Lifetime Income Benefit. Other Transactions X4390 06/20 AK, AL, AR, AZ, CA…
AK, AL, AR, AZ, CA, CO, CT, DC, DE, FL, GA, HI, IA, ID, IL, IN, KS, KY, LA, MA, MD, ME, MI, MN, MO, MS, MT, NC, ND, NE, NH, NJ, NM, NV, OH, OK, OR, PA, RI, SC, SD, TN, TX, UT, VA, VT, WA, WI, WV, WY
Add-On Benefit Election Guaranteed Minimum Withdrawal Benefit
Use this form to add a GMWB. Other Transactions NV4390 04/21 NY
Email Blank Form
Protected Form

Annuities are issued by Jackson National Life Insurance Company (Home Office: Lansing, Michigan) and in New York, annuities are issued by Jackson National Life Insurance Company of New York (Home Office: Purchase, New York). Variable products are distributed by Jackson National Life Distributors LLC. May not be available in all states and state variations may apply. These products have limitations and restrictions. Contact the Company for more information. Jackson is the marketing name for Jackson National Life Insurance Company and Jackson National Life Insurance Company of New York.

Not FDIC/NCUA insured • Not bank/CU guaranteed • May lose value • Not a deposit • Not insured by any federal agency

Jackson works with vendors and other partners to help deliver online and mobile advertisements for Jackson that we think may be of interest to you. For more information about how we utilize cookies and vendors to deliver online advertising, please see our Web Site Privacy Practices.

CMC17302 02/20

Jackson National Life Insurance Company
1 Corporate Way
Lansing, MI 48951